Introdução: Na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), o ensino no internato da Atenção Primária à Saúde (APS) com enfoque em medicina de família iniciou-se em 1997. São promovidas a integração do aluno com a equipe de Programa de Saúde da Família (PSF) e a participação na rotina da equipe por meio dos grupos de educação em saúde, reuniões de equipe, visitas domiciliares, discussões de casos individuais e de família. O cuidado médico é realizado na consulta individual e no seguimento das famílias, sendo enfatizadas a prevenção e a promoção da saúde e a avaliação do paciente buscando a assistência integral. São poucos os estudos sobre a percepção dos alunos sobre a vivência nos estágios em saúde da família. Objetivos: Avaliar a percepção dos alunos do 5° ano de medicina do Curso de Medicina da FMRP-USP quanto à contribuição do estágio em Saúde da Família na formação em atenção primária. Metodologia: Os sujeitos do estudo foram alunos do 5º ano do Curso de Medicina da FMRP no ano de 2005, cuja idade médica foi 23 anos e dos quais 58,3% eram do sexo masculino. A esses alunos foi aplicado questionário estruturado antes e após o estágio. O questionário incluiu itens sobre dados pessoais, importância, contribuição e influência do estágio na formação médica e outros aspectos, como integração com a equipe, mudanças na relação médico-paciente, adequação do estágio no 5º ano e duração. Resultados: Dos 103 respondentes, 75,5% avaliaram o estágio em saúde da família como bastante ou muito importante e 87% consideraram adequada sua inserção no 5º ano. Em relação à duração, 49,5% e 82,5% consideraram suficiente no primeiro e segundo questionário respectivamente. 91,3% referiram boa integração com a equipe. Quanto ao atendimento, 68% perceberam mudanças em sua forma de atender o paciente durante o estágio. Os princípios da estratégia de saúde da família mais percebidos pelos alunos foram acessibilidade e longitudinalidade. Conclusão: Na avaliação dos graduandos, o estágio contribui positivamente para a sua formação, principalmente nos aspectos de integração com a equipe de saúde, humanização e visão dos principais princípios da saúde da família, como trabalho em equipe, longitudinalidade, acessibilidade e atuação na prevenção. Após o estágio o aluno passou a dar mais importância aos aspectos sociais e econômicos do paciente e avaliá-lo com um ser bio-psico-social. / Introduction: At Medical School of Ribeirão Preto of São Paulo Universilty (FMRP-USP), Primary Care (PC) started to be taught in 1997 with emphasis on family medicine. The integration between students and the Family Medicine team is promoted and the students are encouraged to participate in the routine of the team by attending group meetings, team meetings, home visits, and individual and family cases discussion. Medical care is provided during an individual visit and by following up the families, with emphasis on prevention and health promotion and on patient evaluation in an effort to provide complete assistance. There are a few studies about this efford. Objectives: To evaluate the perception of 5th year medical students of FMRP-USP regarding the contribution of the training in Family Health to PC education. Methodology: The study subjects were 5th year medical students of FMRP in the year 2005, to whom a structured questionnaire was applied before and after the training period. Mean age was 23 years and 58,3% were men. The questionnaire contained questions about the following topics: personal data, importance, contribution and influence of the period of training regarding medical education, aspects such as integration with the team, changes in the doctor-patient relationship, and adequacy and duration of the training in the 5th year. Results: Of 103 students, 75.5% evaluated the training in family health as considerably or very important and 87% considered its insertion in the 5th year to be adequate. Regarding duration, 49.5% and 82.5% considered it to be sufficient in the first and second questionnaire, respectively. 91.3% reported good integration with the team. Regarding care, 68% perceived changes in their way to care for the patient during the training period. The principles of the family health strategy most perceived by the students were accessibility and longitudinality. Conclusion: The training contributed positively to the education of the students, especially regarding integration with the health team, humanization and vision of the main principles of family health such as team work, longitudinality, accessibility and prevention. After the training the students started to attribute more importance to the social and economic aspects of the patients and to evaluate the latter as bio-psycho-social beings.

Introdução: Na Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), o ensino no internato da Atenção Primária à Saúde (APS) com enfoque em medicina de família iniciou-se em 1997. São promovidas a integração do aluno com a equipe de Programa de Saúde da Família (PSF) e a participação na rotina da equipe por meio dos grupos de educação em saúde, reuniões de equipe, visitas domiciliares, discussões de casos individuais e de família. O cuidado médico é realizado na consulta individual e no seguimento das famílias, sendo enfatizadas a prevenção e a promoção da saúde e a avaliação do paciente buscando a assistência integral. São poucos os estudos sobre a percepção dos alunos sobre a vivência nos estágios em saúde da família. Objetivos: Avaliar a percepção dos alunos do 5° ano de medicina do Curso de Medicina da FMRP-USP quanto à contribuição do estágio em Saúde da Família na formação em atenção primária. Metodologia: Os sujeitos do estudo foram alunos do 5º ano do Curso de Medicina da FMRP no ano de 2005, cuja idade médica foi 23 anos e dos quais 58,3% eram do sexo masculino. A esses alunos foi aplicado questionário estruturado antes e após o estágio. O questionário incluiu itens sobre dados pessoais, importância, contribuição e influência do estágio na formação médica e outros aspectos, como integração com a equipe, mudanças na relação médico-paciente, adequação do estágio no 5º ano e duração. Resultados: Dos 103 respondentes, 75,5% avaliaram o estágio em saúde da família como bastante ou muito importante e 87% consideraram adequada sua inserção no 5º ano. Em relação à duração, 49,5% e 82,5% consideraram suficiente no primeiro e segundo questionário respectivamente. 91,3% referiram boa integração com a equipe. Quanto ao atendimento, 68% perceberam mudanças em sua forma de atender o paciente durante o estágio. Os princípios da estratégia de saúde da família mais percebidos pelos alunos foram acessibilidade e longitudinalidade. Conclusão: Na avaliação dos graduandos, o estágio contribui positivamente para a sua formação, principalmente nos aspectos de integração com a equipe de saúde, humanização e visão dos principais princípios da saúde da família, como trabalho em equipe, longitudinalidade, acessibilidade e atuação na prevenção. Após o estágio o aluno passou a dar mais importância aos aspectos sociais e econômicos do paciente e avaliá-lo com um ser bio-psico-social. / Introduction: At Medical School of Ribeirão Preto of São Paulo Universilty (FMRP-USP), Primary Care (PC) started to be taught in 1997 with emphasis on family medicine. The integration between students and the Family Medicine team is promoted and the students are encouraged to participate in the routine of the team by attending group meetings, team meetings, home visits, and individual and family cases discussion. Medical care is provided during an individual visit and by following up the families, with emphasis on prevention and health promotion and on patient evaluation in an effort to provide complete assistance. There are a few studies about this efford. Objectives: To evaluate the perception of 5th year medical students of FMRP-USP regarding the contribution of the training in Family Health to PC education. Methodology: The study subjects were 5th year medical students of FMRP in the year 2005, to whom a structured questionnaire was applied before and after the training period. Mean age was 23 years and 58,3% were men. The questionnaire contained questions about the following topics: personal data, importance, contribution and influence of the period of training regarding medical education, aspects such as integration with the team, changes in the doctor-patient relationship, and adequacy and duration of the training in the 5th year. Results: Of 103 students, 75.5% evaluated the training in family health as considerably or very important and 87% considered its insertion in the 5th year to be adequate. Regarding duration, 49.5% and 82.5% considered it to be sufficient in the first and second questionnaire, respectively. 91.3% reported good integration with the team. Regarding care, 68% perceived changes in their way to care for the patient during the training period. The principles of the family health strategy most perceived by the students were accessibility and longitudinality. Conclusion: The training contributed positively to the education of the students, especially regarding integration with the health team, humanization and vision of the main principles of family health such as team work, longitudinality, accessibility and prevention. After the training the students started to attribute more importance to the social and economic aspects of the patients and to evaluate the latter as bio-psycho-social beings.

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 4 uppsatser.

Community nursing services provide health care services in communities outside health care institutions. They are targeted at the sick people in their own home environments, especially providing disease prevention, health support and health care assistance. The goal of community health services is to improve the whole community health, especially of those people who are exposed to risky lifestyles and who are under risk of petting sick, or of dech, and to provide a specific care to them. The introductory part of my thesis contains the theory and elementary parts and types of the health care system in the CR as well as categorized structures and functions of the World Health Organization. It also includes the primary health care goals as well as the goals of the European Union and of the Czech Ministry of Health for the health care system development. In the second part the theory deals with the meaning of the community care, its foundations, the past and the present in the CR. It also describes the nurses´ job descriptions. In the course of the quantitative research I chose the technique of a questionnaire on the grounds of a stratified selection. It was made up by questions used in interviews with nurses. In the frame of qualitative research I chose a method used in interviews with workers in health insurance companies in which I used a guided interview. The goal of my thesis was to find out whether health care workers are aware of health care deficits. I asked for the workers´ opinions on the necessity of community care development in the CR. The goals of my work were reached. The research question was used to find out what the of health care insurance companies representatives´ opinions on the necessity of the community care in the CR are. On the grounds of the questionnaire it was found out that the representatives of health care insurance companies have a positive opinion on the necessity of the community care development in the CR. I did not prove the first hypothesis which stipulated that nurses working outside hospitál facilities do not feel any deficit in providing health care services referring to the provided care. The second hypothesis was proven stipulating that nurses working in hospital facilities can see the most serious deficit in the the fact that people lack their interest in their own health. The third hypothesis was proven, too. The health care workers´ opinions on the the necessity of the community care in the CR are positive.

Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T01:40:18Z (GMT). No. of bitstreams: 1 Sol_NuncioAntonioAraujo_D.pdf: 30048278 bytes, checksum: 049f92b5a39004870d7b6253fa32095e (MD5) Previous issue date: 2011 / Résumé: Cette thèse a comme objectif général sauver, à travers l'Analyse Institutionnelle Socio-Historique, le processus de constitution de la Médecine Générale et Communautaire (MGC) brésilienne à partir de quelques expériences municipales. Important faire ressortir la forte implication de l'auteur avec ce travail être ex-residente de médecine générale communautaire de l'Hôpital Monsenhor Horta dans Mariana/MG. La MCG au Brésil présente de multiples et complexes influences sociales, politiques et culturelles, caractérisée par des éléments idéologiques et conceptuels divers et beaucoup de fois conflictuelles, originaires, au un premiers moments, de scénarios internationaux qui, à accosteront au Brésil, souffrent un processus assimilation " tropicalizada ", lié au choc entre La normatization d'état et de fondations internationales et sa il accomplit de la mise en oeuvre à partir des réalités locales où ils ont été implantés. Nous pourrions supposer l'existence d'un modèle brésilien de MGC? Ainsi, l'hypothèse centrale de ce travail est ce dont MGC au Brésil a présenté des caractéristiques propres qui la diffèrent du modèle original américain, en prévalant, dans le processus d'implantation et de mise en oeuvre, la flexibilité et les innovations de caractère local. S'analyse la mise en oeuvre de la Médecine Générale Communautaire au Brésil dans les décennies de 70 à 90, en élaborant une possible genèse conceptuelle et sociale de MGC à travers l'analyse de trois expériences dans MGC - les Du Centre de Santé-École Murialdo et de Grupo Hospitalier Conceição les deux à Porto Alegre /RS et encore opérant, et ce de l'Hôpital Monsenhor Horta dans Mariana/MG, interrompue en 1984. Il s'agit d'une étude de nature qualitative, de fond simultanément théorique ET empirique, sur base d'entrevues et de recherche documentaire. Des résultats montrent que les trois expériences analysées présentent des différences importantes, tant nous leurs processus d'implantation qu'aussi nous leurs liens institutionnels, politiques et idéologiques. Se détache aussi la variété des expériences concernant la formation de médecins résidants dans le secteur de MGC / Resumo: Esta tese tem como objetivo geral resgatar, através da Análise Institucional Sócio-Histórica, o processo de constituição da Medicina Geral e Comunitária (MGC) brasileira a partir de algumas experiências municipais. É importante salientar a forte implicação do pesquisador com este trabalho por ser ex-residente de medicina geral comunitária do Hospital Monsenhor Horta em Mariana/MG. A MCG no Brasil apresenta múltiplas e complexas influências sociais, políticas e culturais, caracterizada por elementos ideológicos e conceituais diversos e muitas vezes conflituosos, oriundos, num primeiro momento, de cenários internacionais que, ao aportarem no Brasil, sofrem um processo de assimilação "tropicalizada", decorrente do embate entre a normatização estatal e de fundações internacionais e sua efetiva implementação a partir das realidades locais onde foram implantadas. Poderíamos, então, supor a existência de um modelo brasileiro de MGC? Assim, a hipótese central deste trabalho é a de que a MGC no Brasil apresentou características próprias que a diferem do modelo original americano, prevalecendo, no processo de implantação e implementação, a flexibilidade e as inovações de caráter local. Foi analisada a trajetória da Medicina Geral Comunitária no Brasil nas décadas de 70 a 90, elaborando uma possível gênese conceitual e social da MGC através da análise de três experiências em MGC - o do Centro de Saúde-Escola Murialdo e do Grupo Hospitalar Conceição ambos em Porto Alegre/RS e ainda atuantes, e a do Hospital Mons. Horta em Mariana/MG, interrompido em 1984. Trata-se de um estudo de natureza qualitativa, de fundo simultaneamente teórico e empírico, com base em entrevistas semi-estruturadas e pesquisa documental. Os resultados mostram que as três experiências analisadas apresentam diferenças relevantes, tanto nos seus processos de implantação como também nos seus vínculos institucionais, políticos e ideológicos. Destaca-se também a variedade das experiências em relação à formação de médicos residentes na área de MGC / Abstract: This dissertation aims at rescuing, by Socio-Historical Institutional Analysis, the process of constitution of Brazilian General Medicine Community (GMC) from some municipal experiences. It is important to point out the strong implication between the researcher and this study, since he was a former-resident of GMC of Monsenhor Horta Hospital in Mariana/MG. The GMC in Brazil presents multiple and complex social, cultural and political influences, it is also characterized by diverse ideological and conceptual elements and many times conflictive, deriving, at the first moment, from international settings that, when arriving in Brazil, suffered from a process called "tropical like" assimilation, resulting from the shock between the state normalization and international foundations and its effective implementation through the local realities where they were implanted. So, could we suppose the existence of a Brazilian model of GMC? Thus, the central hypothesis of this work would be that the GMC in Brazil presented proper characteristics that differ from the American original model, prevailing, in the process of implantation and implementation, the flexibility and the innovations of local feature. The study analyzed the implementation of Brazilian General Medicine Community in the decades of 70 the 90, elaborating possible conceptual and social genesis of the GMC through the analysis of three different experiences in GMC - Center of Murialdo Health-School and the Conceição Hospital Group, both still operating in Porto Alegre /RS and Mons. Horta Hospital in Mariana/MG, interrupted in 1984. This is a qualitative study of theoretical and empirical background simultaneously, based on semi-structured interviews and desk research. Results point out that the three experiences show relevant differences not only in their insertion processes but also in their institutional, political and ideological bonds. The research also highlights the variety of experiences for the training of medical residents in the area of GMC in Brazil / Doutorado / Ciências Sociais em Saúde / Doutor em Saude Coletiva

Compartilhamos um momento histórico em que Reformas Psiquiátrica e Sanitária mobilizam novos paradigmas de atenção e serviços em saúde. A cidadania, a horizontalidade das relações e o estímulo ao protagonismo dos diferentes agentes aparecem como premissas importantes nos trabalhos. Nesse contexto, o atendimento em grupo representou uma resposta viável por destacar a participação coletiva e reconhecer as trocas interativas como facilitadoras ao processo de saúde e doença. O presente estudo, em consonância a tais premissas, teve por objetivo compreender, por meio da perspectiva dos participantes, um grupo de promoção à saúde e de atenção à experiência cotidiana que tem se desenvolvido há quatorze anos em um serviço de referência em saúde mental na cidade de Ribeirão Preto: o Grupo Comunitário de Saúde Mental (GCSM). Trata-se de uma atividade que se singulariza por propor o cuidado com a participação de profissionais, usuários e familiares sem a distinção de papéis, ou seja, todos fazem uso e se beneficiam do grupo, questionando a histórica diferenciação de profissional/coordenador, aquele que ajuda e usuário/familiar, o que recebe a ajuda. O corpus da pesquisa foi constituído por nove entrevistas abertas em profundidade e pela observação participante ao longo de dois anos e seis meses, com base na Fenomenologia, especialmente de Edmund Husserl. A análise estruturou-se em dois momentos pautados na intencionalidade fenomenológica. No primeiro, destacamos a descrição do fenômeno em que foram apresentadas as nove entrevistas e a observação participante, de maneira a dar visibilidade às vivências e singularidades das experiências sobre o GCSM, sem o destaque de repetições, respeitando a ordem cronológica das exposições, de forma que o interlocutor compartilhe do significado intencionado pela pessoa sobre o vivenciado no grupo. Posteriormente, na análise compreensiva, foram identificadas quatro unidades de sentido por meio da atenção às tendências compartilhadas sobre o GCSM, a saber: 1) grupo e seu contexto generativo que demarcou uma historicidade e uma generatividade para a compreensão e desenvolvimento da proposta; 2) grupo vivido como potencial terapêutico o qual destacou os aspectos estruturais, de composição, os delineamentos técnicos e metodológicos significados sobre o GCSM entre os participantes, em que a experiência vivida aparece como uma via de promoção do cuidado; 3) grupo como espaço de paradoxos que, por sua vez, apresentou as dificuldades e dilemas encontrados na participação, em especial, pela característica simétrica da composição grupal e 4) grupo como uma vivência estética, que ressaltou o uso de elementos artísticos e culturais no processo de atenção à experiência cotidiana. A consolidação dessa proposta de estudo possibilitou a construção de um recorte compreensivo em que o GCSM é significado como uma forma de trabalho exitosa, pelo aprimoramento da proposta de atenção à experiência, diferente do foco tradicional nas hermenêuticas clínicas, convivendo, ao mesmo tempo, com um contexto paradoxal que impele a novas disposições de seus participantes e idealizadores. A pesquisa permitiu colaborar com o entendimento sobre o modo pelo qual as pessoas que sofrem, adoecem e trabalham em contextos de saúde mental vivenciam o cuidado em um grupo simétrico, além de demarcar uma maneira alternativa de cuidado pela via da experiência fenomenológica, representando uma modalidade potencialmente aberta a outros espaços de cuidado em saúde mental / We share a historical moment, in which Psychiatric and Sanitary Reforms still mobilize new paradigms of care and services in health. Citizenship, the horizontality of relations and the encouragement to the role of different actors appear as important premises in the works. In this context, the group service represented a viable answer as it highlights the collective participation and recognizes the interactive exchanges as facilitators to the health and disease process. This study, in line with such assumptions, aimed to understand, through the participants perspectives, a group of health promotion and attention to everyday experience that has been developed for fourteen years, thus becoming a reference service in mental health in Ribeirão Preto: The Mental Health Community Group (GCSM). It is a distinguishing activity that proposes care with the participation of professionals, users and members of the family, without distinction of roles, i.e., all of them make use of the group and benefit from it, by questioning the historical differentiation of professional / coordinator, the one who helps, and the user / family, the one receiving aid. This research corpus consists of nine in depth open interviews and participant observation carried out over two years and six months, based on phenomenology, especially by Edmund Husserl. The analysis was structured in two guided moments, based on the phenomenological intentionality. In the first part, it focuses on the phenomenon description, in which the nine interviews and participant observation were presented, in order to give visibility to the practices and peculiarities of experiences on the GCSM, without the highlight of repetitions, respecting the chronological order of expositions, so that the interlocutor may share the intended meaning experienced by the person in the group. Later, in the comprehensive analysis, four units of meaning were identified through attention to trends shared on GCSM, namely: 1) \"group and its generative context\" which defined both a historicity and a generativity to the proposal knowledge and development ; 2) \"group lived as a therapeutic potential\", which highlighted the structural and compositional aspects, as well as the technical and methodological designs about GCSM among participants, in which the lived experience appears as a means of promoting care; 3) \"group as a space of paradoxes \" which, in turn, presented the difficulties and dilemmas found in participation, in particular, because of the symmetric feature of group composition and 4) \"group as an aesthetic experience\", which emphasized the use of artistic and cultural elements in the process of attention to everyday experience. The consolidation of this proposed study enabled the construction of a comprehensive corpus in that the GCSM is meant as a way of successful work by improving attention to the experience, different from the traditional focus on clinical hermeneutics, concomitant with a paradoxical context that drives to new purposes of its participants and creators. The research collaborated with the understanding of how people who suffer, become ill and work in mental health settings experience care in a symmetric group; it also defined an alternative way of care by means of phenomenological experience, representing a potentially open modality to other mental health care spaces

A formação de recursos humanos para atuar no setor da saúde mental constitui elemento estratégico para a efetiva consolidação do modelo psicossocial de atenção, tendo em vista que a principal tecnologia utilizada nesta área é o próprio trabalhador. Nesse contexto, o presente estudo teve como foco o programa Grupo Comunitário de Saúde Mental (GCSM), desenvolvido na cidade de Ribeirão Preto- SP, que vem atuando como estratégia de ampliação e diversificação dos programas de cuidado em Saúde Mental e também como espaço de formação de profissionais de saúde. Objetivou-se compreender as experiências de estudantes e profissionais em processo de formação com o Programa GCSM e os desdobramentos de sua apropriação no percurso de formação profissional em saúde/saúde mental. Está ancorado em uma abordagem qualitativa de pesquisa e utilizou como instrumentos a observação participante e a entrevista aberta. Os dados foram coletados no período de agosto de 2015 a fevereiro de 2016 e os participantes foram: cinco estudantes das áreas de Enfermagem, Terapia Ocupacional e Fisioterapia e dez profissionais em formação das áreas de Psicologia, Medicina e Serviço Social, totalizando 15 participantes. A análise do corpus foi realizada seguindo os princípios da Análise de Conteúdo Temática e possibilitou a construção de cinco categorias, a saber: 1) A formação em saúde/saúde mental aponta experiências de formação vividas pelos entrevistados e revela um processo formativo atravessado pela centralidade e autoridade do profissional em relação ao paciente e pelo distanciamento afetivo; 2) Primeiros contatos com o GCSM: um novo modelo descreve as experiências iniciais dos entrevistados com uma modalidade grupal inovadora e o processo de ambientação em relação à mesma; 3) O GCSM sob a perspectiva de estudantes e profissionais em formação: a horizontalidade em questão aborda o processo de participação no GCSM, as vivências e apropriações da proposta grupal, sob os pontos de vista individual e relacional. Revela uma ampliação gradual das possibilidades de experimentar o lugar profissional no espaço, concomitantemente a uma maior abertura pessoal e ruptura com um modelo idealizado de profissional; 4) Ampliando olhares acerca da pessoa em sofrimento psíquico: da doença à potência sugere uma ampliação dos olhares e concepções acerca da pessoa em sofrimento psíquico e redução de estereótipos, oportunizada pelo contato, no espaço do GCSM, com outras facetas dos usuários de serviços de saúde mental; 5) O GCSM como experiência formativa aborda os desdobramentos da experiência vivida com o GCSM no percurso de formação em saúde mental e também para outros contextos, revelando uma ampliação dos modos de produzir o cuidado em saúde/saúde mental. Com base na análise empreendida pode-se afirmar que a proposta vivencial, presente no modelo do GCSM, apresenta contribuições tanto do ponto de vista da formação técnica quanto no que tange ao desenvolvimento humano do profissional. Destaca-se que este estudo traz avanços para se pensar a formação realizada em serviços-escola no campo da saúde mental e que tal compreensão pode colaborar com a consolidação do modelo psicossocial de atenção. / The qualification for human resources to work in the mental health area is a strategic element for the effective consolidation of the psychosocial care model, considering that the main technology used in this area is the worker himself. In this context, the present study focused on the Mental Health Community Group (GCSM) Program, developed in the city of Ribeirão Preto, SP, which has been acting as a strategy for expanding and diversifying mental health care programs and also as a qualification space for health professionals. The aim was to understand the experiences of students and training professionals with the GCSM Program and the unfolding of their appropriation in the professional qualification path in health/mental health. It is anchored in a qualitative research approach and used as instruments participant observation and open interview. The data were collected from August 2015 to February 2016 and the participants were: five students from the areas of Nursing, Occupational Therapy and Physiotherapy and ten training professionals in the areas of Psychology, Medicine and Social Work, totaling 15 participants. The analysis of the corpus was carried out following the principles of the Thematic Content Analysis and it enabled the construction of five categories, namely: 1) Qualification in health/mental health - shows formative experiences lived by the interviewees and reveals a formative process crossed by the centrality and authority of the professional in relation to the patient and by affective distance; 2) First contacts with GCSM: a new model - describes the initial experiences of the interviewees with an innovative group modality and the setting process in relation to it; 3) GCSM from the perspective of students and training professionals: the horizontality in question - addresses the process of participation in the GCSM, the experiences and appropriations of the group proposal, from an individual and relational point of view. It reveals a gradual increase in the possibilities to experiment the professional place in the space, concomitantly to a greater personal opening and rupture with an idealized model of professional; 4) Expanding the view of the person in psychological distress: from illness to power - suggests an enlargement of the views and conceptions about the person in psychological distress and reduction of stereotypes, provided by the contact in the GCSM space with other aspects of the users of mental health services; 5) GCSM as a formative experience - addresses the unfolding of experience with GCSM in the course of mental health qualification and also in other contexts, revealing a broader way of producing care in health/mental health. Based on the analysis undertaken, it can be affirmed that the experiential proposal, present in the GCSM model, presents contributions both from the point of view of technical training and with regard to the human development of the professional. It should be emphasized that this study brings advances to think about the training performed in school-services in the mental health field and this comprehension can contribute to the consolidation of the psychosocial model of care.

Magistro baigiamajame darbe išanalizuoti Šiaulių m. savivaldybės bendruomenės sveikatos tarybos veiklos principai, sveikatos politikos formavimas ir įgyvendinimas Šiaulių mieste. Teorinėje dalyje analizuojama Lietuvos savivaldybių bendruomenių sveikatos tarybų veikla, Europos Sąjungos ir Lietuvos sveikatos politikos dokumentai bei jų įgyvendinimas bendruomenėje. Išanalizuota Šiaulių m. bendruomenės sveikatos tarybos sveikatos politikos veiklos kryptys, tarpžinybinis bendradarbiavimas. Ketvirtojoje dalyje nagrinėjamas Šiaulių m. bendruomenės sveikatos tarybos narių požiūris apie sveikatos politikos formavimą ir įgyvendinimą Šiaulių m. savivaldybėje, bendruomenės sveikatos tarybos bendradarbiavimo galimybes ir vykdomos veiklos vertinimą. / In the Master‘s Thesis, the principles of health policy development and implementation from Health Community Council of Siauliai city municipality are analyzed. In the theoretical part, analysis of the Health Community Councils activity of Lithuanian municipalities, the European Union and the Lithuanian health policy documents and their implementation in the community are investigated in a theoretical aspect. Data results on Health Community Council health policy activities and inter-agency cooperation are analyzed as well. In the fourth part, there is considered the approach of Health Community Council members to state their opinion about health policy development and implementation, collaborative capabilities and performance assessment in Siauliai city.